 Welcome once again to the Breakfast on Plores TV Africa. We are joined this morning by Dr Aditya Joseph, she is the founder of Darkass Council Foundation. We're going to be speaking on cancer in children. It's not a conversation that we have a lot here in Nigeria because well, we're going to get to talk about these things. And so we've invited her to share her thoughts on some of these very big issues that are not spoken about a lot. Good morning, Dr Joseph. Joseph, good morning. Good morning. Thanks for having me. Thanks for joining us. So it's not a very popular conversation because a lot of people expect cancer to be, you know, maybe breast cancer, cervical cancer, long cancer, and some of all of that, which happens with older, you know, presumably older persons. Can you share with us, you know, about cancer in children? What are the most common incidents that you've experienced? Yeah, so like you said, it's not a very popular conversation because nobody wants to hear the words cancer and child in the same sentence, so that's understandable. But cancer does happen in children. The most common cancer you find in children is the chemia, which is cancer of the blood. But then there are so many others. There's the one, there's retinoblastoma, which is from the retina of the eye. There are cancers in the kidneys, the muscles, the bones. So there's a whole plethora of cancers that are specific to children and to young adults, adolescents and young adults. Cancer in children is not as common as cancer in adults, but it is often treatable, often curable. They have very, very good survival rates. And so it is more tragic when you see those children die, knowing fully well that with the right treatment, they could easily have survived. So I want to begin first, just generally regarding cancer, the myths concerning cancer in Nigeria. You hear people say, oh cancer, really, I thought I was a big man or a white man disease. Can you help us dispel some of the myths that surround this disease? Well, to start with, when you say a big man disease, the thing about it is that unless you have unlimited funds, cancer is one of the easiest ways to quickly go into bankruptcy, because cancer treatment is expensive anywhere in the world. And so no matter how big that person is, it's one of the most catastrophic things that can happen to anyone's finances. And I have seen it personally over and over again, and I've seen families going to ruin sell everything that they have, which is how the Dockers Foundation even came to start with, because you see parents who sell all of their life savings, they sell all their properties, sell their car. They don't even have a place to live anymore because they're trying to help their child survive. But the chances of that child survival are tanked already because the child came with advanced disease. So no matter what they do, the prognosis was bad from the start. And so until we get to the point where we're detecting it early, that's always going to happen. But regarding the myths in Nigeria, there are many of them. I don't even know where to begin with that. The one thing I will address is two things I will address. Number one is that the treatment for cancer is surgery, chemotherapy, and radiation. There is no diet that is going to cure it. There is no vitamin infusion that is going to cure it. All of those things are lies. And I can say it anywhere. There is no data to support it. The second thing I will talk about is nutrition. Because one of the first questions I get asked by anyone who's diagnosed with cancer is what can I eat? Because people come to them and tell them don't take this, don't take that, don't eat this, don't eat that. And so you have a malnourished, undernourished person coming into treatment which is going to be very taxing to their system. So if I had to pick two myths to address, those would be the two. Okay, so talking about kids and cancer screening, where really lies the challenge? You don't screen children for cancer because like I said, again, it's not as common. Because there are only a few cancers you screen for if you compare it to the number of cancers that can happen. Because the logic behind screening is that there has to be a significant incidence for you to be able to make that screening justifiable. For you to spend the money to do a mammogram for 10,000 women. How much does it cost, first of all, the cancer screening for one child? We don't screen children for cancer. So that's even the challenge because they now come with the advanced stage, we don't screen children for cancer because the cancers are not as common as in adults, number one. Number two is that the screening tests are not 100% reliable. For you to do a screening test it has to be reproducible and it has to be reliable. So I can always say that if I check PSA and PSA is elevated something is wrong with this prostate. You have to have something like that that is consistent for you to be able to use it as a screening test and we don't have anything like that in children. Number three is for the cancer called retinoblastoma which is a cancer that occurs in the retina of the eye. And there's a simple check you can do for that which is you check the eyes to make sure that the part of the eye that is supposed to be white remains white or red remains red. So that's the closest you can come to what you call screening for cancer in children. What children need is a regular health check with somebody who is a pediatrician who is qualified to treat children and who can tell that this is not malaria or typhoid and know that this child needs to be referred for expert attention. What happens is that the child comes to treat for malaria and typhoid and they do that repeatedly over and over again in multiple different centers and then by the time a real diagnosis is reached it's been six months and the disease has spread. So there's a lot of expectations with regards to the causes of cancer from how it's been described you know behavioral habits you know food that you mentioned you know the food that we consume you know bad oil bad drugs, smoking some of all of that. So how would you explain to a parent whose child is down with cancer that hasn't been able to I mean it's not old enough to have lived with those habits. So there are two groups and I like that you separated adults from children. Children don't have these risk factors. They haven't been exposed to these risk factors long enough for them to be relevant. With children it's mostly genetic and when I say genetic I don't mean hereditary necessary. I mean that it is in the genes so it is something that starts from the level of the gene while the baby is even sometimes in the womb and it has nothing to and that's very important to me to emphasize it has nothing to do with what the mother ate or drank or you know understand what I'm saying. Now that's something to say that a woman who is pregnant should not make healthy choices but often those bad choices will show up immediately with a child who is on the weight or who is unhealthy at birth. It's not cancer that is the result of an unhealthy pregnancy. Do you understand what I'm saying? Now that's different from adults. With adults smoking nutrition diet lifestyle all of those things are certainly risk factors but not for children and that's something that is very important to address because many parents feel a lot of guilt and wonder if it's something they did or didn't do and we always make that very clear that it was nothing like that it's like you have an assembly line and you're bringing out sliced bread every now and then one slice is going to be abnormal and what happens in cancer is that the systems that should pick out that abnormal slice fail and they allow it to escape into the system and then that abnormal cell begins to reproduce. So that's what happens. It's not anything that they did or didn't do. Before now you went on to say that maybe a child is sick or you get diagnosed for malaria and typhoid and six months seen they present with advanced stage of cancer you said something like that. What are the signs of cancer in children? There are many different cancers so it's difficult to say there is one specific sign. For the most common cancer. Let's talk about leukemia for example which is one of the things that we see a lot is there is repeated infections so the child keeps getting sick and sick. First of all for people who don't understand help us break down what is leukemia and then go ahead to talk about it. That's going to take us a long time. So leukemia is cancer of the blood and what happens with it is that there is an abnormal proliferation of white blood cells which is the immune system. And because the abnormal cells are proliferating they take over the bone marrow, they starve and push out the other cells. So that child is anemic, that child is predisposed to infection, that child is predisposed to bruising and bleeding and all of that. So that's a very very very simplified version of what happens in leukemia. But then one of the easiest ways, one of the commonest ways they present is that they have repeated illnesses and infections. And so they get treated for an acute infection over and over and over again. And nobody takes a step back to look again to figure out why is this child being sick all the time. And then send them. And the reason that happens is because many times they're not being seen by a pediatrician. They're being seen by somebody who is maybe a GP, who treats adult, who treats children, who treats everyone. And so that index of suspicion for something else is often lacking. Alright, let's talk about the Dockers Foundation. What exactly have you been into since it started? So the Dockers Cancer Foundation is five years old and when the foundation started it was with the intention to support parents financially to pay for treatment. But then like I said, what we found is that there's no point paying millions for treatment. When the child is already coming with a stage four disease and is going to not live anyway. And so as we've gone on, we've had to take a step back to figure out other ways to approach the problem beyond just funding treatment. And so now we've attacked early detection. We've done this Look Again campaign which is training primary healthcare workers and community healthcare professionals across the states. And we've trained over a thousand people now. And the point of the Look Again campaign is teaching them to look for other signs. And understanding that at the point where you see this, you need to refer this child for expert assessment. The truth about it is that not every child in Nigeria can come to a pediatrician every time that they're sick. We don't even have enough pediatricians in the country. So if we can train the people at the community level to know when to refer for expert assessment, that is one step to improve early detection. We've also taken on training of, so for example we don't have any pediatric radiation oncologist in Nigeria. So we recently held a program called the PEDROC where we know trying to build capacity for radiation. We had experts from all over the world training our experts on the ground here to do that. And so we've done many programs like that. We started the pediatric cancer access program. We have funders and donors paid directly to the providers. One of the problems, challenges you'll find is that people are nervous to give money to a foundation, to an NGO, because they want to know how their money was spent. And while we are very open with our books and all of that, just to remove that little bit of nervousness, we say, okay, don't give the money to doccas foundation. Pay it to the hospital. Pay it to the pharmaceutical company. They will supply the drugs directly. The hospital will perform the surgery. So don't give us the money. Pay it to the hospital and we just get the child and bring that child in for their treatment. So what pickup does is that it eliminates the delays in treatment. The child gets treated on credit. The surgery is done. The chemo is given. And then we figure out how to find a donor to pay for the treatment after that. But the child gets treated. So those are some of the things that we've done to try to address the issues that we've discovered beyond just funding treatment. Okay, so I saw reports by the World Health Organization that said that in higher income countries the rate of treatment and cure for cancer in children is 80%. But when you come to low and middle income countries, like in the third world, you find situations where the rate of cure for children who have cancer is 15% to 45%. What can we do to change this? Yeah, so I mean it's exactly what I was saying that it's very tragic because you know that most of the time these children can survive. I tell people all the time that I attend conferences on pediatric cancer and they don't talk about survival. What they talk about is side effects, quality of life, because survival is taken for granted. It is over here that these children are still dying. And so these are the things that we can do to address them. Early care action is very important. Access to care is very important. Treatment funding is very important. Okay, well of course a better healthcare system, I believe because an endurance can't necessarily rely on foundations all through. Could you share with us you said if a child is going to be helped, the treatment is paid for even before the comes. How long does the treatment take on the average? It depends. So surgery is a one day procedure. I mean of course the child is going to be in hospital after to recover. So it depends on the treatment you're talking about. With radiation, I'm a radiation oncologist. We have treatments that are lasting six weeks or you know two months at a time because they're taking daily treatments over a couple of weeks. Chemotherapy can last for months, you know, at different intervals. So it depends on what kind of treatment but I always tell people, so what I tell my patients in the clinic is this, for the next two years of your life, this is the journey you're going to be on at the very minimum. And when you're talking about metastatic disease, it's really most of the time for the rest of your life. So it's not something, it's like and I tell people, it's like hypertension once you become hypertensive, you're hypertensive for the rest of your life. And that's what happens with cancer that is metastatic. And even when it's not metastatic, it's going to take quite a bit of time, dedication, emotional and financial toll on the family. It's really it's a tough one to deal with actually. Anyway Yes, just quickly, I wanted to ask I've heard about the Nigeria Cancer Control Plan and things like that. How would you really quantify government's imputes in trying to find a way to solve this mess of cancer in the country especially with regards to children? Is the government doing enough and what more can they do? This is a topic that I'm very passionate about because I find that a lot of the time it's very easy to have these conversations where you sit down and you complain about the government and all of that. And I tell people that you see even in the best countries so if you take the US for example there are organizations that are committed to lobbying for cancer patients their entire focus of work, the entire scope of work is lobbying the policymakers to make policies that help cancer patients. How do I expect who a minister of finance for example he doesn't know anything about cancer. If I don't bring it to his table and talk to him about it and tell him what the problems are with these solutions it's not his job to think of them for me. So instead of talking about what government has done I tell people what have you done how many people have you talked to about it how many letters have you written do you know who your legislators are have you approached them to talk about it have you asked for research funded what has everybody done about it I'm sorry so that's how I see it. I can we can sit down here and criticize government until next tomorrow but the truth about it is that the average person on the streets has done nothing or not enough and that's where we need to start from. So what do we need to do as Nigerians so let's start by knowing what the problems are so one of the things that I learned in this journey is that initially I used to go and talk a lot about the problems I'll say these are the challenges and then you know and this is something I say all the time there are very few people you're going to talk to to say children are having cancer they're dying and they don't want to do anything they do want to do something so they're going to ask you what can I do and then you're stuck because you've come only with the problems and no solutions so what we need to do is understand what the problems are and come up with the solutions come up with ideas for the solutions and then tell them that okay these are possible solutions these are the ways that the government can help here is the truth there are very few countries in the world where government is funding cancer treatment in full it's very expensive there are other things that can be done so you can encourage private industry to invest in cancer treatment by giving them tax breaks every private company that do needs to cancer treatment will get a whatever percentage tax break anybody who is importing equipment for cancer treatment will not pay importation fees those are the kind of things that government can do but we can't expect them to solve the entire solution okay so the entire problem in 10 seconds does the health insurance also cover cancer treatment no right now cancer coverage by health insurance in Nigeria is maybe one percent I think cancer treatment yes it's very low it's next to nothing and that is another that's another thing that government can help with because the insurance companies themselves have to stay in business all right I wish we had enough time to talk about how COVID-19 affects cancer patients because the fact we've seen is that it affects them at a higher risk but I guess this is where we can draw the line here thank you very much Dr. Adelia Joseph from the Dockers counter foundation thank you for having me and this is where we will be saying goodbye on the Thursday thanks for staying with us if you missed out on these conversations you want to catch up remember it's at plus TV Africa on Facebook and Instagram same with our YouTube channel along with at plus TV Africa lifestyle I am also give a and I am Annette Felix saying bye bye